NEW 03/01/2024 ML #3829)
Purpose
The purpose of Waiver Personal Care (WPC) is to provide a range of assistance to enable waiver participants to accomplish tasks that they would normally do for themselves if they did not have a physical disability.
Service Description
Waiver Personal Care assistance may take the form of hands-on assistance (actually performing a task for the person), cuing to prompt the participant to perform a task or being at the ready to assist with the tasks due to the individuals intermittent need for personal care and supervision. Such assistance may include assistance in performing ADLs (bathing, dressing, toileting, transferring, maintaining continence) and IADLs (more complex life activities, i.e., light housework, laundry, meal preparation, grocery shopping, using the telephone, medication, and money management). Such assistance also may include the supervision of participants as provided in the service plan.
Service Eligibility, Criteria for
The individual receiving Waiver Personal Care service will meet the following criteria:
Must be eligible for Medicaid Waiver for Home and Community-Based Services.
Requires on-going daily support with the combination of personal care and supervision as defined under waiver services of Waiver Personal Care and Supervision.
The individual must be capable of directing their own care or has a legally responsible party to act on the recipient’s behalf.
Service Tasks/Activities
The care needs of the individual must fall within the scope of personal care service as described in this service chapter. The care needs may include a combination of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Either the individual must have the ADLs and IADLs needs performed for him/her OR an individual with cognitive impairment may be able to complete the activity ONLY with supervision, guidance, or prompting.
Personal Care tasks that may be included in Waiver Personal Care are as follows: bathing, communication, dressing/undressing, eye care, feeding/eating, hair care/shaving, housework, incontinence, laundry, meal preparation, medication assistance, mobility, money management, fingernail care, shopping, skin care, teeth/mouth care, toileting, transferring/turning/positioning, cog/supervision, exercises, hoyer lift/mechanized bath chairs, indwelling catheter, medical gases, prosthesis/orthotics, suppository/bowel program, TED socks, temp/bp/pulse/respiration rate, apnea monitor, jobst stockings, ostomy care, postural/bronchial drainage, and RIK bed care. The identified tasks for the individual are listed on the service authorization.
The task of supervision is allowed between other personal care tasks, if the individual requires supervision/oversight due to physical or cognitive impairment, or to be at the ready to provide personal care services when personal cares are required intermittently throughout the day.
Supervision means having the knowledge of, and account for, the activity and whereabouts of the recipient at all times to allow immediate provider intervention as necessary to safeguard the individual from harm. Supervision includes the provider being immediately available to furnish assistance and direction throughout the performance of and/or at the ready to perform the next personal care task (i.e. bathing, toileting, transferring, locomotion etc.) that is necessary to meet the intermittent personal care need of the participant.
Homemaker (laundry, shopping, and housekeeping) tasks are to be included in the service of WPC.
The service of waiver personal care is not intended to be used primarily for environmental tasks. The individual must have a daily personal care and/or supervision need to qualify for this service.
Waiver Personal Care (WPC) may be provided on an episodic or on a continuing basis.
WPC is an all-inclusive service that combines personal care services, intermittent personal care, supervision, homemaker and limited to the amount of time that care is provided to the eligible individual while moving from task to task or completing tasks simultaneously within the authorized amount of time.
Example 1: If the provider is providing supervision, PCS at the ready, hands-on PCS, meal preparation and homemaker.
Such as, a provider may be providing supervision and preparing a meal at the same time then move to assisting with PCS and then completing homemaker tasks. The all-inclusive nature of WPC allows for all the tasks to be completed while the provider is clocked in under the one service of waiver personal care.
Example 2: If the individual requires assistance with personal care, supervision, meal prep, and homemaker all in one day/shift, the provider can provide all of these tasks while remaining clocked in under the service of Waiver Personal Care.
Such as, an individual requires staff to be in the home and at the ready for PCS tasks and there are homemaker tasks or a meal that needs to be prepared. It is allowable for the QSP to provide the services simultaneously, and does not require units for each task to be authorized independently, however the task itself must be authorized under the service plan and authorization.
Waiver Personal Care Daily Live-in Providers
Live-in waiver personal care (daily) is all inclusive of personal care, supervision and homemaker services.
Waiver Personal Care Daily live-in must be authorized if the non-family provider and the individual live in the same residence and personal care and supervision is needed on a daily basis.
If personal care/supervision is not needed on a daily basis, Waiver Personal Care Daily live-in should not be authorized.
If there are multiple waiver personal care providers necessary to meet the individual's need, it is allowable for unit-based waiver personal care to be authorized instead of waiver personal care daily.
Qualified Service Provider (QSP) Service Agreement - Live In Paid Caregiver, SFN 1654, is required for all live in WPC Daily Personal Care Providers.
Limits/Service Combinations
To avoid duplication, waiver personal care recipients are not eligible for adult residential care, adult foster care, residential habilitation, and community support services.
Waiver Personal care differs from adult foster care in that personal care is provided in the individual's home, and adult foster care is provided in the service provider's home. If a non-relative is caring for the individual on a 24-hr live in basis in the provider’s home, the service must be Adult Foster Care. It cannot be Waiver Personal Care service.
Waiver personal care differs from respite care in that respite care is provided to relieve the primary, live-in caregiver, whereas the primary purpose of waiver personal care is to provide the care an individual needs and not to relieve the caregiver.
Homemaker (Laundry, shopping, and housekeeping) tasks when provided as a waiver personal care service limited set by the department, and the cap cannot be exceeded under other waiver services.
The number of reimbursable hours of care for an Individual Qualified Service Provider (QSP) of this service cannot exceed 12 hours per day.
The state assures WPC being provided to the participant are not duplicative of extended personal care as WPC does not include hands-on care of a medical nature that is specific to the needs of an eligible individual that is provided under extended personal care. The state ensures non-duplication with extended personal care through thorough assessment and monitoring of participant services through person centered planning.
Personal care under the waiver differs in scope, nature, supervision arrangements, and/or provider type (including provider training and qualifications) from personal care services in the state plan. Waiver Personal Care differs in scope and nature from the personal care offered under the State Plan as supervision may be provided under WPC. A participant cannot be authorized to receive both services at the same time.
When WPC is provided by a non-agency provider, participants are responsible for overseeing and supervising individual providers on an ongoing basis. Additionally, the case manager performs monitoring of a participant’s person-centered plan with the participant. This monitoring includes monitoring of the use or non-use of waiver services. At a minimum, this monitoring occurs on a quarterly basis.
The individual or legally responsible person must direct the care provided and should be involved in training and monitoring the WPC QSP as much as possible and when appropriate.
Personal care services that can be covered under the state plan should be furnished to waiver participants under the age of 21 as services required under Early and Periodic Screening, Diagnostic and Treatment (EPSDT). If an individual under age 21 is seeking waiver services, the case must be staffed with program administration.
Service Location
Services will be administered in the most integrated setting consistent with the Person-Centered Plan of Care, including (checked if allowable):
ü The individual's home
ü Workplace
ü Other community service settings
Waiver Personal Care is furnished both inside and outside the participant’s home and community. WPC may be provided outside the participants home when the participant is needing personal cares while outside of their home.
Example: If the individual needs personal care assistance hands on or at the ready to provide services outside of the home to meet their needs. It is allowable under WPC. WPC cannot be used in lieu of Companionship (to include community integration and socialization), Extended Personal Care or Non-medical Transportation-Escort.
Personal care may be furnished in order to assist a person to function in the workplace or as an adjunct to the provision of employment services.
Providers
Waiver Personal Care Daily Rate may be provided by (checked if allowable):
ü Legally Responsible Person
Relative
ü Legal Guardian
Waiver Personal Care Unit Rate may be provided by (checked if allowable):
ü Legally Responsible Person
ü Relative
ü Legal Guardian
Standards for Waiver Personal Care Providers
All providers of waiver services must be enrolled Qualified Service Provider N.D.A.C. 75-03.23-07.
Qualified Service Provider (QSP) Service Agreement - Live In Paid Caregiver, SFN 1654, is required for all live in Waiver Personal Care Daily Providers.
When WPC is provided by a non-agency provider, participants are responsible for overseeing and supervising individual providers on an ongoing basis. Additionally, the case manager performs monitoring of a participant’s person-centered plan with the participant. This monitoring includes monitoring of the use or non-use of waiver services. At a minimum, this monitoring occurs on a quarterly basis.
WPC Daily Rate Providers must:
Be live in caregivers of Medicaid Waiver eligible individuals who provide daily personal care (including being at the ready to provide intermittent personal cares and/or supervision.)
Have a close personal relationship with eligible individuals.
If more than one live in QSP is an authorized provider, do not use a daily rate. The services should remain as WPC unit rate.
Complete a Qualified Service Provider (QSP) Service Agreement - Live In Paid Caregiver, SFN 1654.
See Standards for Qualified Service Providers 525-05-45